Ketorolac Use and Anastomotic Leak in Elective Colorectal Surgery: A Detailed Analysis
| Autor: | Molly M. Ford, Timothy M. Geiger, Adam B. King, Roberta L. Muldoon, Matthew D. McEvoy, Jonathan P. Wanderer, M. Benjamin Hopkins, Barbara J. Martin, Alexander T. Hawkins |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Leak Anastomotic Leak Anastomosis Patient Readmission 03 medical and health sciences 0302 clinical medicine medicine Humans Surgical Wound Infection Aged Retrospective Studies business.industry Incidence Anti-Inflammatory Agents Non-Steroidal Gastroenterology Retrospective cohort study General Medicine Perioperative Acute Kidney Injury Middle Aged Tennessee Colorectal surgery body regions Ketorolac Elective Surgical Procedures 030220 oncology & carcinogenesis Anesthesia Female 030211 gastroenterology & hepatology Elective Surgical Procedure business medicine.drug Cohort study |
| Zdroj: | Diseases of the Colon & Rectum. 61:1426-1434 |
| ISSN: | 0012-3706 |
| DOI: | 10.1097/dcr.0000000000001244 |
| Popis: | Background Recent population-level analyses have linked ketorolac use to adverse outcomes. However, its use is also associated with decreased opioids and faster return of bowel function. Objective This study aims to assess the association between ketorolac and anastomotic leak. We hypothesize that receiving at least 1 dose of ketorolac will not be associated with anastomotic leak in elective colorectal surgery. Design This is a retrospective, observational cohort study of a prospectively collected data base. Anastomotic leak rates and other patient outcomes were adjusted for patient-level factors and then compared via a multivariable logistic regression. A secondary analysis assessed a dose-response association with anastomotic leak. Setting This study was conducted at a tertiary care colorectal surgery service. Patients Consecutive patients undergoing elective colorectal surgery with a nondiverted anastomosis were identified from 2012 to 2016. Intervention Exposure was defined as any administration of ketorolac during the perioperative time period. Main outcome measures The primary outcome measured was anastomotic leak. Results A total of 877 patients met inclusion criteria. Of these, 479 (54.6%) were women, and the median age was 55 years. Overall, 566 (64.5%) patients were exposed to ketorolac. In the cohort, 27 (3.1%) patients experienced an anastomotic leak. In an unadjusted analysis, there was no association between ketorolac exposure and anastomotic leak (ketorolac: 3.1% vs no ketorolac: 3.3%; p = 0.84). This persisted in a multivariable model (OR, 0.98; 95% CI, 0.38-2.57; p = 0.98). Neither AKI (OR, 3.24; 95% CI, 0.51-20.6; p = 0.21), return to the operating room (OR, 1.07; 95% CI, 0.40-2.85; p = 0.88), nor readmission (OR, 1.03; 95% CI, 0.59-1.80; p = 0.93) was associated with ketorolac use. In a secondary analysis of patients receiving ketorolac, there was no association between total ketorolac dosing and anastomotic leak (OR, 0.99; 95% CI, 0.99-1.00; p = 0.20). Limitations This study was a retrospective review, and there was a low incidence of anastomotic leak. Conclusion Ketorolac exposure was associated with neither anastomotic leak nor other important postoperative outcomes. See Video Abstract at http://links.lww.com/DCR/A784. |
| Databáze: | OpenAIRE |
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